Provider Demographics
NPI:1568793081
Name:DOHERTY, NOAH STEVEN (LPN)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:STEVEN
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CROSS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3644
Mailing Address - Country:US
Mailing Address - Phone:845-942-2051
Mailing Address - Fax:
Practice Address - Street 1:2 CROSS CREEK LN
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-3644
Practice Address - Country:US
Practice Address - Phone:845-942-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297694164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297694OtherLICENSED PRACTICAL NURSE